Comparative evaluation of conventional to left molar and right molar laryngoscopy and endotracheal intubation

Abstract

Background: Difficulty in visualizing the glottis may cause difficulty, even failure in endotracheal intubation leading to catastrophes. Difficult laryngoscopy is frequently overcome by using molar approach for laryngoscopy combined with optimal external laryngeal manipulation (OELM). The present study was planned to compare conventional midline approach of laryngoscopy to left molar and right molar approach of laryngoccopy (using Macintosh blade) for endotracheal intubation Material and Methods: This prospective randomized double blind controlled study was conducted on 120 patients of 18-60 years age, belonging to ASA grade I and II of either sex, posted for elective surgery under general endotracheal anaesthesia. Depending on the approach of laryngoscopy used, the patients were randomly divided into three groups of 40 each into Group M (midline approach), Group L (left molar approach) and Group R (right molar approach). Predictors of difficult intubation (Modified Mallampati grading, Thyromental distance, abnormal Dentition) and their association with unsuccessful intubation, Cormack Lehane grading, attempts of intubation, duration of intubation, success rate of intubation, adjuvant measures needed (stylet, retraction of mouth) for intubation were noted. Results: Patients having predictors of difficult intubation had significant risk of unsuccessful intubation with midline approach (p=0.01 for MPG III/IV, p=0.04 for TMD